CATEGORY: Business Services AUTHORIZED BY: Lori Weber Business Services Manager
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1 POLICY TITLE: Financial Assistance Program DEPARTMENT: All Departments LAST REVIEWED: October 2015 LAST REVISED: October 2015 ORIGINATION DATE: May 2012 CATEGORY: Business Services AUTHORIZED BY: Lori Weber Business Services Manager POLICY Danette Kramer, MBA, CHFP Chief Financial Officer Regional Medical Center (RMC) provides, without discrimination, care for emergency conditions and other medically necessary care regardless of financial assistance eligibility or ability to pay. Consistent with its mission to deliver compassionate, high quality, affordable healthcare services, and to advocate for those who are poor and disenfranchised, RMC will provide financial assistance, or charity care, to individuals who meet the criteria established in this policy. Charity is not considered to be a substitute for personal responsibility. Patients are expected to cooperate with RMC s procedures for obtaining financial assistance and other forms of payment, and to contribute to the cost of their care based on their individual ability to pay. Individuals with the financial capacity to purchase health insurance shall be encouraged to do so, as a means of assuring access to healthcare services, for their overall personal health, and for the protection of their individual assets. In order to manage its resources responsibly and to allow RMC to provide the appropriate level of assistance to the greatest number of persons in need, the Governing Board of Trustees establishes the following guidelines for the provision of patient charity. DEFINITIONS For the purpose of this policy, terms below are defined as follows: Charity Care Healthcare services that have or will be provided but are never expected to result in cash inflows. Charity care results from a provider s policy to provide healthcare services free or at a discount to individuals who meet the established criteria. Household Members Adults residing together (married or significant others) and dependent children, under the age of 18, are considered household members. Household Income Includes earnings, unemployment compensation, workers compensation, Social Security, Supplemental Security Income, public assistance, veterans payments, survivor benefits, pension or retirement income, interest, dividends, rents, income from estates, trusts, alimony, child support, and other miscellaneous sources. Uninsured Annual Review: 5/2015 Page 1 of 5
2 The patient has no level of insurance or third party assistance to assist with meeting his/her payment obligations. Underinsured The patient has some level of insurance or third party assistance but still has out-of-pocket expenses that exceed his/her financial abilities. PROCEDURE Services Eligible under this Policy For purposes of this policy, charity refers to healthcare services provided without charge or at a discount to qualifying patients. The following healthcare services are eligible for charity: emergency and other medically necessary services billed by RMC, Regional Family Health (RFH), and Regional Medical Home Care (RMHC)/Hospice of Comfort (HOC). Charity will not be granted for accounts in legal action or accounts already written off to bad debt due to bankruptcy filing. If the applicant is found eligible for full or partial assistance, the following providers are included in RMC s FAP policy: Services billed by RMC: Hospital facility Inpatient and Outpatient Services ED Provider fees CRNA (anesthesia and pain clinic professional services) Dr. Douglas Cooper (Orthopedic Physician) Hospitalists on staff at RMC RFH Providers Sleepy Study interpretations Pulmonary professional fees for Dr. Wilson, Dr. Geisler, and Dr. Peterson RFH immunization and billable nursing services The following provider s services are not eligible for FAP: NE Iowa Podiatry PC Dr. Messerly Radiology Consultants of Iowa (RCI) Outside reference labs (Weland, Quest, etc.) Alere Home Monitoring Medical Associates PC UnityPoint Cardiology Physicians Clinic of Iowa (PCI) Oncology Associates OB-GYN Associates Tri-State Dialysis Fuerste Eye Clinic Great River Oral Dubuque Urology Dubuque Neurology Fox Eye Laser Institute Dubuque Internal Medicine Dubuque Head-Neck Mercy Cardiology Clinic Don Joy Orthopedics (DJO) Annual Review: 5/2015 Page 2 of 5
3 Eligibility for Charity Eligibility for charity will be considered for those individuals who are uninsured, underinsured, ineligible for any government healthcare benefit program, and who are unable to pay for their care, based upon a determination of financial need in accordance with this policy. The granting of charity shall be based on an individualized determination of financial need, and shall not take into account age, gender, race, social or immigrant status, sexual orientation, or religious affiliation. Assistance will be available up to $10,000 per calendar year for each household. Requests for assistance in excess of $10,000 will be reviewed by the Business Services Manager. Determination of Financial Need Financial need will be determined in accordance with procedures that involve an individual assessment of financial need. This includes an application process, in which the patient or the patient s guarantor are required to cooperate and supply personal, financial, and other information and documentation relevant to making a determination of financial need. Base income guidelines are adjusted annually and are based on 300% of the Federal Poverty Guidelines. The schedule showing income guidelines for free or discounted care is attached to this policy. Items needed to make the determination for financial need are as follows: 1) If employed outside of the home, paystubs for applicant and spouse or significant other residing in the same home for the prior three (3) months of the date of the application (only dependent children under the age of 18, and spouse or significant others are included in household size). Also required, is the most recent income tax return showing the Total Adjusted Gross Income (AGI). An average between the last three (3) months income and the Total AGI off the tax return is taken to determine the eligibility level (example, a patient qualifies 100% based on the last three [3] month s income but only qualifies 50% based on income tax, the patient would qualify 75% based on income alone). Note: Only the income tax return is used in determining eligibility level for self-employed applicants. 2) Any unpaid medical and/or dental expenses or any medical and/or dental expenses paid in the three (3) months prior to the date of the application. The eligibility level may be increased depending on total medical debt. 3) Proof of application to the Medicaid program through the Department of Human Services (DHS) for any individuals who may potentially be eligible. Note: Individuals who have filed Form 4029 Application for Exemption from Social Security and Medicare Taxes and Waiver of Benefits for religious reasons, will be exempt from the requirement to apply for Medicaid. *Financial Assistance Clerk will gather all data and ensure all necessary documents are present to process the application and will make a preliminary eligibility determination. Limiting Gross Charges RMC limits the charges to individuals eligible for financial assistance to not more than the amount generally billed to those who have insurance coverage for such care. Therefore, patients who have no insurance coverage and who qualify for partial financial assistance will receive a discount off gross charges equal to the interim Medicare adjustment rate. If the Medicare reimbursement rate exceeds the hospital charge rate, the hospital will apply the prompt pay discount (currently 20% of gross charge) before the financial assistance adjustment is applied to the account. Application Processing and Timelines Annual Review: 5/2015 Page 3 of 5
4 *The Business Services Coordinator will review the application and supporting documents and make the final approval for eligibility and will enter the applicant s name, household members, eligibility level, and the date of approval on the Financial Assistance Plan (FAP) Log located on the L network drive. *Once the final approval is made, the Financial Assistance Clerk will enter the FAP on applicable accounts in the Patient Accounting System and will send a tickler to the Information Systems (IS) Department to post the adjustment to the account. *RMC will make a written conditional or final determination of eligibility with 14 days of the receipt of all required information. *When financial assistance is granted, each date of service may only be considered for discount once. *Assistance will be granted for future services for a six (6) month period from the date of application. Patients may reapply for assistance during this six (6) month period if a qualifying event occurs. Examples of qualifying events include birth or adoption of a child, loss of employment, or catastrophic health event. *Financial assistance will not be applied to accounts already written off to bad debt due to bankruptcy. *Accounts in legal action (small claims court) will not be eligible for financial assistance unless it has been less than 240 days from the date of the first billing statement. Presumptive Charity There are instances when a patient may appear eligible for charity care discounts, but there is no financial assistance form on file due to lack of supporting documentation. Often, there is adequate information provided by the patient or through other resources, which could provide sufficient evidence to provide the patient with charity care assistance. The following situations will be allowed for Presumptive Charity: 1) Deceased patients with no estate, 2) Patients with Medicare and Medicaid as a supplemental insurance with balances due for selfadministered drugs. Communication of the Charity Program to Patients and the Public: Notification about charity available from RMC, which shall include a contact number, shall be disseminated by RMC by various means, which include, but are not limited to, the publication of notices in patient bills and by posting notices in all registration/check-in areas of the hospital and clinics (including Satellite Clinics), and hospital and clinic business offices that are located on facility campuses. Information shall also be included on the facility s website. A request for charity may be made by the patient or a family member, close friend, or associate of the patient, subject to applicable privacy laws. Annual Review: 5/2015 Page 4 of 5
5 Annual Review: 5/2015 Page 5 of 5
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